Process improvements in family practice lead to some improvements in intermediate outcomes
Patient Safety and Quality
Process-of-care measures often form the core of pay-for-performance programs. Improvements in processes of care are significantly associated with improved patient outcomes for high blood pressure, stroke, diabetes, coronary heart disease, and epilepsy, according to a new study. The total outcome improvement attributable to improved processes of care ranged from 17.7 percent for high blood pressure to 34.7 percent for stroke. Outcomes improvement for the other conditions measured was 29.6 percent for diabetes, 25.6 percent for coronary heart disease, and 29.1 percent for epilepsy.
The researchers studied specific processes of care for these five diseases and patient outcomes in the setting of a major pay-for-performance program. For processes of care, the researchers used all of the available indicators relating to measurement of disease parameters, including blood pressure, cholesterol, blood glucose level (HbA1c), beta blocker or other medicine prescribed. For outcomes, they used all available intermediate outcome indicators, including control of HbA1c, control of cholesterol, and control of blood pressure. Data came from 7,228 family practices in the United Kingdom's Quality and Outcomes Framework pay-for-performance program.
The researchers conclude that the process improvement reported in their study accounted for a small-to-moderate percentage of total outcome improvement. Their findings may accelerate a shift in policy focus away from processes and toward outcomes as measures of clinical effectiveness in the United Kingdom. The study was supported by the Agency for Healthcare Research and Quality (HS18546).
See "The effect of improving processes of care on patient outcomes" by Andrew M. Ryan, Ph.D., and Tim Doran, M.D., in the March 2012 Medical Care 50(3), pp. 191-199.